Magnesium – the underestimated and essential mineral
Magnesium Deficiency – Health Risks and Implications
Magnesium is a vital mineral that plays a fundamental role in various physiological processes within the human body. Despite its significance, magnesium deficiency remains a prevalent and often overlooked health concern, even in developed countries where nutritional awareness is relatively high. The body needs calcium for the muscles to contract, but magnesium for the muscles to relax. It is estimated that 10-30% of the population in developed countries lack at least a slight magnesium deficiency (DiNicolantonio et al. 2018). Magnesium deficiency (hypomagnesemia) is when bodies can’t function normally because of a lack of magnesium in the diet. In the body it is present as Mg2+, which is concentrated in the bones (around 60%) and soft tissues (40%). Currently the Magnesium level is measured by the magnesium concentration within the blood/urine, even though nearly 100% of the bodies Magnesium is found elsewhere. Only <1% is in the blood. (Piuri et al. 2021a) Abnormal potassium or calcium levels may lead to your doctor referring you to a test. It is essential for healthy bones, muscles, nerves, the release of neurotransmitters and blood and sugar levels. The major symptoms of magnesium deficiency include muscle twitching, digestive problems (diarrhea, constipation or both), irritability, fatigue and weakness, dizziness, which may also include nausea and vomiting palpitations and racing heart, low appetite inner restlessness, depressive states, numbness in the limbs, headaches and circulatory disorders. Magnesium inadequacy is also frequent in obese patients and subject with type-2 diabetes, metabolic syndrome as well as other diseases. (Piuri et al. 2021a; NIH 2022)
While magnesium is an essential mineral for overall health, and a deficiency can lead to various health issues, the benefits of additional magnesium intake, even in the absence of a deficiency, can depend on individual circumstances. Some groups of people who may benefit from extra magnesium include, but are not limited to:
Athletes: Intense physical activity can lead to an increased loss of magnesium through sweat and urine. Magnesium is involved in cellular energy production pathways such as adenosine triphosphate (ATP) and is therefore essential for muscle muscle function and recovery. For athletes (especially during intense training) it’s vital to have a functioning metabolism and to rely on proper muscle contractions and recovery. Mg inadequacy might lead to muscle cramps and hinder the recovery process. Further Mg is an electrolyte, involved in maintaining the bodies fluid balance. Imbalances may occur during physical activity through sweating. A proper Mg intake contributes to a proper electrolyte balance and helps to prevent dehydration. Furthermore, it helps maintaining a healthy cardiovascular system, reliable bones, it also helps in the immunomodulation and increases the sleep quality. At last, it also supports the nutrient metabolism such as carbohydrates and fats. Thus, athletes may benefit from additional intake to support their performance and recovery. (Zhang et al. 2017)
Elderly individuals: Older adults may have reduced magnesium absorption and an increased risk of magnesium deficiency. Adequate magnesium intake can help support bone health, muscle function, and cardiovascular health in the elderly. (Barbagallo et al. 2021)
Individuals with certain medical conditions: Some medical conditions or medications may affect magnesium absorption or increase the body’s demand for magnesium. Conditions such as diabetes, gastrointestinal disorders, and alcohol dependence can lead to magnesium depletion. In such cases, additional magnesium intake may be beneficial. (NIH 2022)
Migraine sufferers: Some studies suggest that magnesium supplementation may help reduce the frequency and intensity of migraines in individuals who experience these headaches. (Deborah Tepper 2013)
Women with premenstrual symptoms: Magnesium supplementation (often combined with Vitamin B6) has been proposed as a potential support for relieving symptoms associated with premenstrual syndrome (PMS), such as mood swings and bloating. (Parazzini et al. 2017)
Individuals under chronic stress: Chronic stress can deplete magnesium levels in the body. Magnesium is involved in the body’s stress response and may help mitigate the negative effects of chronic stress. (Pickering et al. 2020)
Depressed and anxious individuals: Mg has been found to be helpful in treating depression and anxiety, either alone or with antidepressants. Mg helps to balance and regulate glutamate receptors in the brain, which moderates both psychiatric and neurological symptoms. Low levels of magnesium have been linked to the development of depression. (Tarleton et al. 2019; Tarleton and Littenberg 2015; Tarleton et al. 2017)
Obese / Type-2-diabetes: A study published in the journal Nutrients suggests that magnesium deficiency is frequent in obese patients, subjects with type-2 diabetes and metabolic syndrome, both in adulthood and in childhood. The review highlights critical issues about the treatment of magnesium deficiency, such as the lack of a clear definition of magnesium nutritional status, the use of different magnesium salts and dosage, and the different duration of magnesium supplementation. Despite the lack of agreement, an appropriate dietary pattern, including the right intake of magnesium, improves metabolic syndrome by reducing blood pressure, hyperglycemia, and hypertriglyceridemia. This occurs through the modulation of gene expression and proteomic profile as well as through a positive influence on the composition of the intestinal microbiota and the metabolism of vitamins B1 and D. (Piuri et al. 2021b)
People suffering from insomnia or are looking to improve their longitude and quality of sleep:
Mg helps to balance and regulate glutamate receptors in the brain, which moderates both psychiatric and neurological symptoms. Low levels of magnesium have not only been linked to the development of depression. It also plays a role in sleep health. A systematic review of available literature suggests that magnesium deficiency is associated with sleep disorders. Observational studies suggest an association between magnesium status and sleep quality, while randomized clinical trials show an uncertain association between magnesium supplementation and sleep disorders. However, magnesium supplementation with 320–900 mg of magnesium daily has been found to bring significant improvement in sleep efficiency, sleep time, and sleep onset latency and early morning awakening, especially in older adult. (Arab et al. 2023)
Magnesium is involved in over 300 enzymatic reactions in the body, it is a cofactor for over 600 enzymes and an activator for an additional 200 enzymes, influencing energy metabolism, protein synthesis, and nerve function. (Al Alawi et al. 2018; Fiorentini et al. 2021) Despite its critical role, several factors can contribute to magnesium inadequacy. The problem with our Mg intake is that these factors often combine and there is a higher chance of Mg deficiency. The most problematic reasons for the lack of intake can be separated by major and minor causes:
Minor reasons for magnesium inadequacy might be:
- Water Filtration Systems:
Filtration system preferences vary globally. North America commonly employs reverse osmosis (RO) systems, Europe often uses activated carbon and ceramic filters, Asia frequently relies on multi-stage systems, and Africa may depend on well water or basic filtration methods.
In North America commonly RO systems are used and effectively remove impurities but may also eliminate essential minerals, including magnesium.
Europe employs carbon filters, which primarily target organic contaminants and do not significantly alter magnesium concentrations.
Asian countries mostly use multi-stage filtration systems, that vary in their effects on magnesium content, depending on the included processes.
Africa usually relies on well-water or basic filtration methods. Basic filtration methods in Africa, such as sediment filtration or boiling, may have minimal impact on magnesium content, while Magnesium content in water from wells or natural sources is contingent on geological conditions, leading to variable concentrations.
Soft water, which is common in various households, usually has a low concentration of minerals, especially calcium and magnesium ions. This water is the result of a process called water softening (through soft water ion exchanger), in which the hard Ca and Mg ions are replaced by sodium ions. This process is primary done, because of plumbing issues or personal preferences. Therefore, soft water is consumed by plenty individuals. Drinking water with low magnesium content may contribute to overall magnesium inadequacy.
In the ion exchange process the sodium content in the water increases, which may also result in a consideration for individuals on a sodium-restricted diet. The potential reduction of Ca and Mg raises concerns about the impact on the daily dietary mineral intake. Consuming soft water with low magnesium levels can be a contributing factor to magnesium inadequacy.
- Elderly individuals (Age), as mentioned above, have a decreased magnesium absorption and increased excretion, leading to potential deficiencies.
- Excessive alcohol intake and other, certain lifestyle choices can interfere with magnesium absorption and increase urinary excretion.
- Imbalanced ratios of calcium to magnesium in the diet may affect the absorption of magnesium. A diet excessively high in calcium relative to magnesium can hinder magnesium absorption.
- Chronic stress can lead to magnesium depletion due to increased urinary excretion.
- Insulin resistance could be linked to elevated magnesium excretion, contributing to deficiency.
These are the most prevalent reasons of the various causes of magnesium deficiency, further it is necessary to mention the consequential health risks associated with inadequate magnesium levels. The factors contributing to magnesium deficiency lay the basis for understanding its potential impact on overall health. The relationship between the intake and the functions within the body imply the importance of maintaining adequate levels of Mg. Each reason contributes to the individual understanding of why magnesium inadequacy might be a burden to such a large amount of the western population. As Mg is such a vital mineral, there are different health risks associated with magnesium deficiency:
Insufficient magnesium levels may contribute to abnormal heart rhythms and increase the risk of heart attacks. Magnesium deficiency is linked to an increased risk of cardiovascular diseases, including hypertension and atherosclerosis. Further Mg is essential for bone formation and density. Deficiency may compromise bone integrity and contribute to osteoporosis. Low magnesium levels also negatively impact calcium metabolism, further affecting bone health. Magnesium is crucial for proper nerve function and muscle contraction. Deficiency may lead to neurological symptoms, such as muscle cramps, spasms, and weakness, this may also include tremors and seizures in severe cases. Mg plays a role in insulin sensitivity and glucose metabolism. Deficiency may contribute to metabolic disruptions, such as insulin resistance and increase the risk of type 2 diabetes. Newer research suggests a link between magnesium deficiency and mental health disorders, including anxiety and depression. Mg is involved in the regulation of neurotransmitters and the stress response, making it integral to mental well-being.
How Magnesium Deficiency can be addressed:
By encouraging the consumption of magnesium-rich foods, such as leafy greens, nuts, seeds, and whole grains. People suspected to inadequacy should promote a well-balanced diet that includes a variety of nutrient-dense foods. Please see the table below for an overview of Mg rich foods and on which scale they benefit the bodies Mg-status.
| Food | Magnesium (mg) per 100g | % of RDA per 100g |
|---|---|---|
| Spinach, Boiled | 556 | 148% |
| Roasted Pumpkin Seeds | 550 | 147% |
| Chia Seeds | 486 | 130% |
| Almonds, Dry Roasted | 286 | 76% |
| Cashews, Dry Roasted | 267 | 71% |
| Peanut Butter, Creamy | 179 | 48% |
| Peanuts, Oil Roasted | 168 | 45% |
| Black Beans, Cooked | 120 | 32% |
| Halibut, Cooked | 91 | 24% |
| Edamame, Shelled, Cooked | 60 | 16% |
| Whole Wheat Bread (1 Slice) | 56 | 15% |
| Instant Oatmeal (1 Packet) | 55 | 15% |
| Yogurt, Plain, Low-Fat | 53 | 14% |
| Cereal, Oats (2 Large Biscuits) | 49 | 13% |
| Brown Rice, Cooked | 44 | 12% |
| Raisins | 43 | 11% |
| Fortified Breakfast Cereal | 42 | 11% |
| Salmon, Atlantic, Farmed, Cooked | 37 | 10% |
| Kidney Beans, Canned | 35 | 9% |
| Avocado, Cubed | 29 | 8% |
| Banana | 27 | 7% |
| Ground Beef, 90% Lean, Pan-Broiled | 27 | 7% |
| Baked Potato with Skin | 24 | 6% |
| Chicken Breast, Roasted | 24 | 6% |
| Soy Milk, Plain or Vanilla | 22 | 6% |
| White Rice, Cooked | 20 | 5% |
| Broccoli, Chopped and Cooked | 12 | 3% |
| Milk | 11-13 | 3-3.5% |
| Carrot, Raw | 8 | 2% |
| Apple | 5 | 1% |
In cases of suspected inadequacy Mg supplementation may be necessary. Different forms of Mg supplements are available, and the choice depends on individual needs and tolerances. A bioavailable form of Mg is preferred over a non-bioavailable form. Usually, water-soluble forms of Mg are more bioavailable. During supplementation, not only the form of Mg is important, but also what other ingredients you might ingest with the mixed supplement. Therefore, by orally ingesting magnesium supplements it is better to go with pure composition with fewer additives. Please see the table below for an overview of different Mg.
| Magnesium Oxide: | This form has a low bioavailability and is often used as a laxative. It contains a higher percentage of elemental magnesium by weight but is less easily absorbed by the body. |
| Magnesium Sulfate: | Commonly known as Epsom salt, it is more often used for external applications like baths rather than as a dietary supplement. Its bioavailability is relatively low when taken orally. |
| Magnesium Citrate | This form is more bioavailable than magnesium oxide and sulfate. It is a commonly used magnesium supplement due to its moderate absorption rate and is known for its mild laxative effect. |
| Magnesium Lactate | This form is a combination of magnesium and lactic acid. It has better bioavailability compared to magnesium oxide and magnesium sulfate. |
| Magnesium Gluconate | is a Mg salt of gluconic acid. It is better absorbed than magnesium oxide and is often used in supplements. |
| Magnesium Aspartate | This form is combined with aspartic acid, and it may have better bioavailability than magnesium oxide. It is thought to be more easily absorbed by the body. |
| Magnesium Chloride | Is often found in topical magnesium products (like oils and lotions) and has good absorption through the skin. When taken orally, its bioavailability is moderate. |
| Magnesium Orotate | a combination of magnesium and orotic acid. Some studies suggest that this form has good bioavailability, and it is often marketed as being well-absorbed by the body. |
| Magnesium Taurate | This form combines magnesium with taurine. Taurine is believed to enhance magnesium's entry into cells, potentially improving absorption. |
| Magnesium Bisglycinate (or Magnesium Glycinate): | This form is chelated with the amino acid glycine. It is highly bioavailable and is often recommended for individuals who may experience gastrointestinal issues with other forms of magnesium. |
| Magnesium Malate | is a compound of magnesium and malic acid. It is well-absorbed and is sometimes preferred by those seeking magnesium to support energy production. |
| Magnesium Threonate | is a newer form that shows promise for crossing the blood-brain barrier. It is believed to be particularly effective in enhancing magnesium levels in the brain, making it a focus for cognitive health. |
| Magnesium Succinate | is a form of magnesium combined with succinic acid. This form is considered to have good bioavailability, and succinic acid itself is involved in energy metabolism. |
| Magnesium Ascorbate | a combination of magnesium and ascorbic acid (vitamin C). This form provides both magnesium and vitamin C, potentially offering additional benefits. It is absorbed well by the body and is a suitable option for those looking to supplement both magnesium and vitamin C simultaneously. |
Understanding that not all forms of magnesium are equally tolerated and absorbed by the digestive system is important. Magnesium oxide, magnesium chloride, and magnesium citrate are more likely to causing digestive discomfort and are less effective in replenishing Mg levels due to their poor absorption compared to other Mg forms. These variants often leave magnesium in the bowel, attracting water, which can result in digestive upset or diarrhea.
Conclusion:
Magnesium deficiency poses a significant health risk and can be caused by various causes. it is impacting various physiological functions and contributing to the development of chronic diseases. Addressing this issue requires include broad changes of life, including dietary modifications, supplementation when necessary, and increased awareness among both the public and healthcare professionals. By prioritizing magnesium intake, individuals and societies can take a proactive step towards optimizing health and well-being.
Publication bibliography
Al Alawi, Abdullah M.; Majoni, Sandawana William; Falhammar, Henrik (2018): Magnesium and Human Health: Perspectives and Research Directions. In International Journal of Endocrinology 2018, p. 9041694. DOI: 10.1155/2018/9041694.
Arab, Arman; Rafie, Nahid; Amani, Reza; Shirani, Fatemeh (2023): The Role of Magnesium in Sleep Health: a Systematic Review of Available Literature. In Biol Trace Elem Res 201 (1), pp. 121–128. DOI: 10.1007/s12011-022-03162-1.
Barbagallo, Mario; Veronese, Nicola; Dominguez, Ligia J. (2021): Magnesium in Aging, Health and Diseases. In Nutrients 13 (2), p. 463. DOI: 10.3390/nu13020463.
Deborah Tepper, M. D. (2013): Magnesium and Migraine. Edited by The Headache Center Cleveland Clinic. American Migraine Foundation. Cleveland, OH, USA. Available online at https://americanmigrainefoundation.org/resource-library/magnesium/, updated on 10/20/2021, checked on 12/30/2023.
DiNicolantonio, James J.; O’Keefe, James H.; Wilson, William (2018): Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. In Open Heart 5 (1), e000668. DOI: 10.1136/openhrt-2017-000668.
Fiorentini, Diana; Cappadone, Concettina; Farruggia, Giovanna; Prata, Cecilia (2021): Magnesium: Biochemistry, Nutrition, Detection, and Social Impact of Diseases Linked to Its Deficiency. In Nutrients 13 (4). DOI: 10.3390/nu13041136.
Mohn, Emily S.; Kern, Hua J.; Saltzman, Edward; Mitmesser, Susan H.; McKay, Diane L. (2018): Evidence of Drug-Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update. In Pharmaceutics 10 (1). DOI: 10.3390/pharmaceutics10010036.
NIH (2022): Office of Dietary Supplements – Magnesium. Fact Sheet for Consumers. National Institutes of Health – Office of Dietary Supplements. Available online at https://ods.od.nih.gov/factsheets/magnesium-healthprofessional/, updated on 6/2/2022, checked on 12/30/2023.
Parazzini, Fabio; Di Martino, Mirella; Pellegrino, Paolo (2017): Magnesium in the gynecological practice: a literature review. In Magnesium research 30 (1), pp. 1–7. DOI: 10.1684/mrh.2017.0419.
Pickering, Gisèle; Mazur, André; Trousselard, Marion; Bienkowski, Przemyslaw; Yaltsewa, Natalia; Amessou, Mohamed et al. (2020): Magnesium Status and Stress: The Vicious Circle Concept Revisited. In Nutrients 12 (12), p. 3672. DOI: 10.3390/nu12123672.
Piuri, Gabriele; Zocchi, Monica; Della Porta, Matteo; Ficara, Valentina; Manoni, Michele; Zuccotti, Gian Vincenzo et al. (2021a): Magnesium in Obesity, Metabolic Syndrome, and Type 2 Diabetes. In Nutrients 13 (2), p. 320. DOI: 10.3390/nu13020320.
Piuri, Gabriele; Zocchi, Monica; Della Porta, Matteo; Ficara, Valentina; Manoni, Michele; Zuccotti, Gian Vincenzo et al. (2021b): Magnesium in Obesity, Metabolic Syndrome, and Type 2 Diabetes. In Nutrients 13 (2), p. 320. DOI: 10.3390/nu13020320.
Rao, Theertham Pradyumna; Quartarone, Giuseppina (2019): Role of guar fiber in improving digestive health and function. In Nutrition (Burbank, Los Angeles County, Calif.) 59, pp. 158–169. DOI: 10.1016/j.nut.2018.07.109.
Tarleton, Emily K.; Kennedy, Amanda G.; Rose, Gail L.; Crocker, Abigail; Littenberg, Benjamin (2019): The Association between Serum Magnesium Levels and Depression in an Adult Primary Care Population. In Nutrients 11 (7). DOI: 10.3390/nu11071475.
Tarleton, Emily K.; Littenberg, Benjamin (2015): Magnesium intake and depression in adults. In J Am Board Fam Med 28 (2), pp. 249–256. DOI: 10.3122/jabfm.2015.02.140176.
Tarleton, Emily K.; Littenberg, Benjamin; MacLean, Charles D.; Kennedy, Amanda G.; Daley, Christopher (2017): Role of magnesium supplementation in the treatment of depression: A randomized clinical trial. In PLOS ONE 12 (6), e0180067. DOI: 10.1371/journal.pone.0180067.
The Nutrition Source (2019): Magnesium. Available online at https://www.hsph.harvard.edu/nutritionsource/magnesium/, updated on 3/7/2023, checked on 1/9/2024.
Wind, Anne E.; Takken, Tim; Helders, Paul J. M.; Engelbert, Raoul H. H. (2010): Is grip strength a predictor for total muscle strength in healthy children, adolescents, and young adults? In European journal of pediatrics 169 (3), pp. 281–287. DOI: 10.1007/s00431-009-1010-4.
Zhang, Yijia; Xun, Pengcheng; Wang, Ru; Mao, Lijuan; He, Ka (2017): Can Magnesium Enhance Exercise Performance? In Nutrients 9 (9). DOI: 10.3390/nu9090946.
